title: Difference of health-care associated pneumonia between large hospitals and small hospitals in Japan.
abstract: OBJECTIVE
  Health-care associated pneumonia (HCAP) is a new category of pneumonia. We investigated differences of epidemiology, pathogens, and outcomes between HCAP patients in large hospitals and those in small hospitals.
  
  
  METHODS
  This was a retrospective observational study of patients hospitalized with HCAP from December 2009 to March 2010. HCAP was defined according to ATS/IDSA criteria. A large hospital was defined as ≥ 200 beds and a small hospital was <200 beds.
  
  
  RESULTS
  Of 117 patients, 61 patients were admitted to large hospitals and 56 patients were admitted to small hospitals. There was a significant difference of HCAP diagnostic criteria between the two groups. The A-DROP severity class was worse in the large hospital group than the small hospital group (P<0.05). Respiratory failure and disturbance of consciousness were more frequent in the large hospital group (P<0.05). The mortality rate was 8.2% in the large hospital group versus 1.8% in the small hospital group. Patients in the very severe A-DROP class had a high mortality rate of 33% in both groups.
  
  
  CONCLUSIONS
  Patients with severe HCAP were more likely to be admitted to large hospitals. Patients in the very severe A-DROP class should receive intensive antibiotic therapy, but not all patients need broad-spectrum therapy.
authors.affiliation: Department of Respirology and Rheumatology, Faculty of Medicine, Tottori University, Nishimachi, Yonago, Japan.
authors.forename: Masanari
authors.initials: M
authors.lastname: Watanabe
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kato
authors.forename: Kenichi
authors.initials: K
authors.lastname: Takeda
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Konishi
authors.forename: Jun
authors.initials: J
authors.lastname: Kurai
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Tatsukawa
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Yoshisato
authors.initials: Y
authors.lastname: Tamura
authors.forename: Soichiro
authors.initials: S
authors.lastname: Ishikawa
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kawasaki
authors.forename: Masato
authors.initials: M
authors.lastname: Morita
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Yoneda
authors.forename: Hidechika
authors.initials: H
authors.lastname: Fujise
authors.forename: Yuki
authors.initials: Y
authors.lastname: Fujise
authors.forename: Kazuomi
authors.initials: K
authors.lastname: Fujise
authors.forename: Kosuke
authors.initials: K
authors.lastname: Yamaguchi
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Hayabuchi
authors.forename: Keji
authors.initials: K
authors.lastname: Shigeshiro
authors.forename: Satoru
authors.initials: S
authors.lastname: Katayama
authors.forename: Hiroki
authors.initials: H
authors.lastname: Chikumi
authors.forename: Tadashi
authors.initials: T
authors.lastname: Igishi
authors.forename: Akira
authors.initials: A
authors.lastname: Yamasaki
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Hasegawa
authors.forename: Ryota
authors.initials: R
authors.lastname: Okazaki
authors.forename: Naoto
authors.initials: N
authors.lastname: Burioka
authors.forename: Eiji
authors.initials: E
authors.lastname: Shimizu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D005260:Female; D006742:Hospital Bed Capacity; D006761:Hospitals / Q000145:classification; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D011014:Pneumonia / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality